Remote RN Utilization Management – Must live in Nevada

Job Overview

  • Clinical License RN
  • State(s) NV

Job Title: Remote Registered Nurse – Utilization Management (Temp-to-Perm)

Location: Remote (Must be local to Nevada for potential future full-time opportunities)

Schedule: Monday to Friday, 8am-5pm PST, with a preferred Saturday shift and a day off during the week, preferably Wednesday or Monday.

Pay Rate: $38-40/hour

Overview: We are seeking a Registered Nurse (RN) for a remote position with a Healthcare company. The role involves working with our Utilization Management team, primarily focusing on inpatient medical necessity and utilization review. The ideal candidate will ensure that our members receive timely and appropriate care, adhering to state and federal regulations and guidelines.

Responsibilities:

  • Conduct concurrent reviews and prior authorizations for Molina Healthcare members.
  • Determine appropriate benefits, eligibility, and expected length of stay for treatments and procedures.
  • Collaborate with interdisciplinary teams to enhance continuity of care, including Behavioral Health and Long Term Care.
  • Maintain productivity and quality standards.
  • Attend regular meetings and assist in mentoring new team members.
  • Complete assigned objectives and projects in a timely manner.
  • Foster professional relationships with providers and internal/external stakeholders.
  • Consult with and refer cases to Molina medical directors as needed.
  • Ensure compliance with workplace safety standards and company policies.

Qualifications:

  • Graduate from an Accredited School of Nursing.
  • Minimum of 3 years hospital acute care/medical experience.
  • Active, unrestricted State Registered Nursing (RN) license in good standing in Nevada.
  • Excellent communication, organizational, and problem-solving skills.
  • Ability to work independently and manage multiple priorities effectively.
  • Proficiency in Microsoft Office products and other relevant software.
  • Familiarity with Interqual and other references for length of stay and medical necessity determinations.
  • Experience with NCQA preferred.
  • Ability to maintain confidentiality and comply with HIPAA regulations.
  • Strong interpersonal skills and ability to establish positive work relationships.

This position offers an opportunity to contribute to improving patient outcomes and ensuring cost-effective care delivery. If you are a motivated and adaptable Registered Nurse with a commitment to quality and efficiency, we encourage you to apply.

www.MorganStephens.com
 

 

 

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